Уважаемые доктора, подскажите, что думать! 2 дня назад приходила пациентка, средний возраст, есть гипертония с доброкачественным течением, хр. Ишемия головного мозга. А обратилась с жалобой на внезапное покраснение левого глаза. Ни боли, ни каких то субъективных ощущений нет, кроме легкой болезненности при надавливании на глаз снизу. На щелевой лампе видно что есть расширение глубоких сосудов конъюнктивы. Больше ничего, все остальное без особенностей, зрение не страдает. Подобные симптомы возникают периодически то на левом то на правом глазу, есть связь с головной болью, причем болит та же половина головы, где глаз покраснел. Никогда не встречалась с таким, хотя конечно и практики еще мало. Надеюсь, что подскажете!
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6. We talked about itching eyes. Again, you’re thinking that the patient has dry eyes or maybe some sort of allergy. However, anytime you can’t get rid of an itching, burning, red eye with medication and long-term treatment, you should really be thinking thyroid eye disease, especially in a woman 40 years old and older. Patients can present with redness or irritated, tearing eyes, or maybe, say, their glasses aren’t working so well. They are otherwise healthy, but nothing cures the eye problem. These patients may have been to 10 different doctors to get help, trying artificial tears, steroids, ointments, lid scrubs, hot compresses, cold compresses, acupressure or acupuncture. If the itching doesn’t get better, thyroid eye disease should definitely be on your radar. A great catch phrase is, “If it’s red, consider TED,” as in Thyroid Eye Disease. It’s obviously easy to pick up if the eyes are bulging out, but the presentation could be very, very subtle. Again, if you see a little mild redness, you should check for lid retraction, which can present as a fellow eye ptosis; you have to make sure that it’s really not a ptosis. If it’s a thyroid eye disease, you then have to go through the whole workup.
7. Somewhat related is the seventh topic, red eyes. You can be going down the road of dryness, while it could be something else. It could be a viral conjunctivitis or superior limbic keratoconjunctivitis, which could also be associated with thyroid eye disease. It is always important to look for nasolacrimal duct obstruction. Take a look at the canaliculi to make sure that you aren’t dealing with some sort of canaliculitis. It’s something that’s very easily overlooked. There can be an infection in a lacrimal sac that can actually be causing redness in the eye, or dacryocystitis. It’s important to look at that lacrimal sac and the lacrimal duct to make sure that everything is wide open.
8. Red eyes could also be a sign of something called a carotid cavernous (CC) fistula, which is related to increased orbital venous pressure, and thus congestion in the eye vasculature. It is, obviously, very serious, requiring treatment. The CC fistula presents typically as a unilateral, very red eye with engorged corkscrew arterialized conjunctival vessels, a very interesting pattern. With a CC fistula, you’re looking for chemosis and elevated intraocular pressure, vision loss, diplopia, sometimes a pulsatile proptosis, even retinal vein congestion or just some plain old conjunctival hyperemia. It is really important to consider that, when a vessel doesn’t look normal, there’s typically a reason why. The other thing to consider when you see these weird-looking conjunctival vessels in a red eye is choroidal melanoma and other cancers of the eye. Make sure that the weird blood vessels aren’t originating from some place or aren’t part of a sentinel vessel that’s associated with a tumor.
перелистайте доступные книги и [Ссылки доступны только зарегистрированным пользователям ] и обязательно найдете, а может и нет. Исключайте опухоли, эндокринную офтальмопатию, ККС и т.п. Головные боли и расширенные сосуды глаза - требуют контроля.
спасибо за цитату и ссылку, я в процессе поиска возможных причин и консультацию невролога и эндокринолога пациентке рекомендовала (пойдет ли?), но даже предварительный диагноз сформулировать пока не могу...
27.07.2013, 16:14
Линейный вид
